Organization Active NPI

Michele Ann Roberts, P C

  • Gerontology Nurse Practitioner
  • Valley Park, MO
National Provider Identifier
1811044233
Registry record updated Jan 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
MICHELE ANN ROBERTS, P C
Practice address
13612 Big Bend Rd
Valley Park, MO 63088-1447
Phone
(314) 578-2100
Fax
(636) 333-4510
NPI assigned
Jan 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michele A Roberts, CNPNPI 1467451708
Title
Owner
Phone
(314) 578-2100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Gerontology Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LG0600X Primary

Addresses

Primary practice location

13612 Big Bend Rd
Valley Park, MO 63088-1447

Mailing address

PO Box 323
Ballwin, MO 63022-0323
Phone (314) 578-2100

Other identifiers 1

IdentifierTypeStateIssuer
428953418MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070329000096 MO Part B Supplier - Clinic/Group Practice 8527162684 Receives reassigned benefits from 3 practitioners
Practice locations: Saint Peters, MO; Valley Park, MO; Union, MO; St Peters, MO; St Louis, MO; St Charles, MO; O Fallon, MO; Eureka, MO…

National Provider Directory

National Provider Directory

Locations

6209 Mid Rivers Mall Dr
Saint Peters, MO 63304
Phone (314) 487-7215

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768694400000",
    "number": "1811044233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 323",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630220323",
            "telephone_number": "314-578-2100",
            "fax_number": "636-333-4510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13612 BIG BEND RD",
            "city": "VALLEY PARK",
            "state": "MO",
            "postal_code": "630881447",
            "telephone_number": "314-578-2100",
            "fax_number": "636-333-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHELE ANN ROBERTS, P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2026-01-18",
        "certification_date": "2026-01-18",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-578-2100",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "428953418",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Park, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.